ACCORDING TO A NEW STUDY, HIP FRACTURES MAY NEARLY DOUBLE worldwide by 2050. How can you lower your risk of suffering a traumatic bone break? Today we explore dodging hip fractures.
I often talk with my patients about reducing their risk of suffering from a broken hip. Hip fractures can be life-changing, with many older individuals never regaining full mobility or independence after suffering from the injury. Many require full-time care. Finally, breaking a hip can be life-threatening.
Today we look at hip fracture basics before turning to incidence, symptoms, causes, diagnosis, and prognosis. I want to focus on how healthy lifestyle choices can significantly influence your risk of a hip fracture.
Hip fracture — Basics
A hip fracture occurs when the upper thigh bone (femur) breaks. Often, the injury is secondary to a traumatic fall or a motor vehicle accident. Hip fractures are more common in older individuals as the bones weaken and become increasingly brittle.
Look at the X-ray image above: The upper femur fractured from a traumatic accident. Such fractures usually result in severe pain and require immediate surgical intervention.
How common are hip fractures?
Worldwide, there is much geographic variation in hip fracture incidence. Industrialized countries have much higher rates than developing regions, with the highest rates in North Europe and the United States. The lowest rates are in Latin America and Africa. Asian countries such as China, Iran, and Kuwait have intermediate rates.
There are differences along the north-south axis in Europe and the United States, with more cases seen in the north. Relevant variables include latitude, ethnicity, environmental factors, and the proportion of elderly in the population.
Hip fractures among older individuals are a leading public health problem. The United States has the highest hip fracture rate in the world because older adults are the fastest growing group in the American population, with a doubling of those aged 65 and older by 2040, from 39 million today to 89 million.
Looking elsewhere, the number of elderly is increasing most rapidly in Asia, Latin America, the Middle East, and Africa. These places will account for over 70 percent of the nearly 6.3 million hip fractures expected in 2050.
Every year, over 300,000 individuals over 65 are hospitalized for hip fractures in the United States.
Hip fractures are often associated with significant morbidity. The most common comorbidities of those suffering from a hip fracture are congestive heart failure, chronic pulmonary disease, and diabetes.
When hip fractures prevent movement for a long time, potential complications include blood clots in the legs or lungs, bedsores, pneumonia, and further loss of muscle mass, increasing the risk of falls and injuries.
Many lose independence, and some will die because of the bone break. An estimated 14 to 58 percent of those who sustain a hip fracture will die within a year.
The relative risk of death in the older population increases four percent per year, with the first being the most critical. While the premature mortality risk decreases substantially over the first two years, it never returns to that of those who have not sustained a hip fracture.
Hip fracture risk factors
A severe impact (for example, a motor vehicle accident) can cause a hip fracture in individuals across the age spectrum. For older individuals, the fracture is most commonly due to a fall from a standing height. Those with weak bones may break their hip by simply standing on a leg and twisting.
The Mayo Clinic (USA) offers these hip fracture risk factors:
- Age and sex. Our risk of a hip fracture rises with age as bone density and muscle mass tends to decrease over time. Moreover, our vision and balance can be problematic, increasing the fall risk. Hip fractures are at least three times more common among women than men. This higher incidence among women is partly due to estrogen level drops (and associated accelerated bone loss) that occur with menopause. Men sometimes have dangerously low bone density levels, too.
- Medical conditions. Osteoporosis is a condition that weakens bones. Those with an overactive thyroid can have fragile bones. Perhaps not surprisingly, those with balance problems (such as individuals with Parkinson’s disease, a stroke history, or peripheral neuropathy) can have a higher fall risk. Low blood sugar or blood pressure can lead to falls. Finally, some intestinal disorders reduce vitamin D absorption, and calcium also can cause weakened bones.
- Certain medicines. Medicines such as long-term steroids (including prednisone) can weaken bones. Drugs that cause dizziness can be problematic, as can medicines such as antipsychotics, sedatives, and sleep medications.
- Nutritional problems. Insufficient vitamin D (and calcium) in younger folks lower peak bone mass and increase the future risk of fracture. Those who are underweight have a higher risk of bone loss.
- Lifestyle. A lack of regular weight-bearing exercise (for example, walking) is associated with weaker bones and muscles, increasing fracture risk. Finally, tobacco and alcohol use are associated with bone loss.
Hip fracture risk reduction: DODGING HIP FRACTURES
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